City of Gheel: Community Mental Health in Action

The patients come from all over Belgium. Before entering foster care, a team from Gheel Central Psychiatric Hospital carefully screens them. Psychiatrists, psychologists and social workers determine who will be eligible for the program. Dangerous patients, pedophiles, are automatically excluded. Once a patient is placed, a psychiatric nurse, like Mark [? Hendrix, ?] and a psychologist, like [? Wilfred ?] [? Bogart, ?], monitor the relationship.

Do you see improvement in their conditions as they spend more time in this family situation?

I think they are feeling better. That's very important. After a time, they feel better. Because when they are entering a family, the family tries to give them responsibility. Even very light things-- to wash dishes, to clean up the house, to work with the garden-- such little thing. And by getting this responsibility, they're feeling better. If you're someone in an institution, they never get such responsibility.

For 45 years, Jeff and Clara have lived together as brother and sister. She was a mentally ill child when Jeff's mother took her in. When his mother died, he took over the responsibility. Today it's sometimes difficult to determine just who is looking after who. And so it is with Caroline, Paulina and Liliana, who call themselves The Three Musketeers. Paulina spent decades in various institutions and has been cared for by Caroline for the last eight years. So has Liliana, whose been with the family for more than 30 years. They share household chores, go out together, and seem as inseparable as the musketeers themselves.

They are not dangerous. They [INAUDIBLE] every time the same thing, and then we laugh with them. And we know them so-- they are very friendly. We like them here. It's a custom in here, so we can live very good with the people. It's normal for us.

Patients still have to take the psychiatric medicines. But still, by these patients, a number of them are getting lower and lower medication after a while.

You reduce the medication.

Usually after, let's say, six months, if we see some stability in the situation of the patient, and then the level of neuroleptic medication that's given to a patient is reduced.

[? Marsalina's ?] retarded and has serious behavioral problems. She's been living with the family of Chris and [? Magda ?] [? Roadams ?] for eight years, along with two other patients, Erma and Margaretta, and the [? Roadams ?] four children. The [? Roadams ?] receive about $13 a day, per patient. That stipend is an important incentive. But according to mental health professionals, money alone cannot account for the warmth within these extended families.

[? Barrett ?] has been with the [? Loehmalin ?] family for most of his life. He was first taken in by Joseph [? Loehmalin's ?] mother. When she died in 1970, [? Barrett ?] moved in with Joseph. It's simply the done thing in this town. Mark is 32 and has been diagnosed as schizophrenic. For four years, he's been living with [? Stef ?], his foster father, and Hugo, another patient. He keeps in touch with his biological parents but feels more secure with his foster family.

Why are you here in this foster family?

I don't really know, but I don't mind being here, so I don't ask myself why I'm here. I think the people are good here, and I like it here.

You feel at ease?

Yes, very, very well. In the beginning, it was a little bit problem, but now it's going very well, I think.

How did you learn to speak English so well?

First of all, in school, and then in university I had some English. And then it's watching very much television I also learn much more English.

Jan Van [? Rentzenbergen ?], the director of the central hospital, oversees the family care program.

We have our own hospital connected to the family care system. So whenever a patient is in a crisis, or he had a problem, or he was not behaving properly in that family, he's taken in again. For one week, for two weeks, for as long as it takes until he's stabilized again. And then he can go back. So being taken away from the family, we put in our central hospital-- even that small step [INAUDIBLE] is felt, for a patient, as a very severe punishment.

The institution-- I think all they do there is giving you pills, and for the rest they don't look at you. But here, you really get people look out for you.

Of the 650 family care patients, about 250 go out to jobs in workshops run by the hospital. They do bicycle repair, simple woodworking jobs, electronic assembly, and packaging for local businesses. Dr. Matthew Dumont, a psychiatrist at the Westborough State Hospital near Boston, was one of the first American doctors to study Geel's approach to the mentally ill.

It's not just the treatment of the patients, and the fact that they are integrated in the town. It is the impact on the rest of the community, not involved with family care of patients, of a social system where, everywhere else in the world, a population that is socially marginalized, treated with disdain, abhorred, feared, is accepted, tolerated, welcomed. You would not see a person lying in the street, homeless in Geel. Whether or not they were a patient, there would be a sense of responsibility for that person. There would be a community concern for anything that looked bizarre, or disorganized, or threatening of a child.

A population that treats the mentally ill with such acceptance, with such tolerance, is a tolerant community. It's a community defined by it's inclusiveness, rather than exclusive. And I think that's quite beautiful.